Texas Health Plan Compare
If you don't have a health plan through your job, you can buy coverage from an insurance company.
Use this website, Texas Health Plan Compare, to find the plan that works best for you.
Other ways to find coverage include:
You can buy a health plan during open enrollment. Open enrollment runs from November 1 - December 15.
If you miss open enrollment, you may not be able to enroll until the next one—unless you have a qualifying life event.
Take time to review your medical needs. It's hard to know your future healthcare needs. But looking at your past can help you choose a better health plan. Ask yourself:
If you visit the doctor often, you may want a plan with a higher monthly premium and lower deductible.
If you will need to see specialists, a PPO plan may be best for you. (See below.)
If you expect to spend a lot on medical costs this year, you may want a plan with a lower out-of-pocket cost and higher monthly premium.
These are the plan types you can choose from:
|
Plan types |
Does the plan cover in-network or out-of-network doctors? |
Do you need a referral for specialists? |
Good option if: |
|---|---|---|---|
|
HMO |
In-network |
Yes |
You want to pay lower out-of-pocket costs |
|
PPO |
Both |
No |
You want a wide range of healthcare provider options both in-network and out-of-network |
|
POS |
In-network |
No |
You want to pay lower out-of-pocket costs and choose your own specialists |
|
EPO |
In-network |
No, if the specialist is in-network |
You want to pay lower out-of-pocket costs and you don’t need a lot of provider choices |
The four parts of a health plan to closely look at are:
Here are more questions to ask yourself when looking at a plan:
On this website, when you compare plans, you can view each plan’s “summary of benefits.” When you read through a summary, make sure you check out:
Note: All health plans in Texas must offer certain benefits—including prescription drugs, emergency services, maternity, mental health, and many more. View the full list of mandated health benefits in Texas.
A plan's network is the group of doctors, hospitals, specialists, and other healthcare providers that are covered. For example, your current primary care provider will be either "in-network" or "out-of-network" for a health plan.
Seeing an in-network doctor usually costs less than seeing an out-of-network doctor.
When reviewing a plan, look at the list of in-network providers—also known as "preferred providers." You can usually find a link to the full list of preferred providers on the first page of a plan's summary on this website.
Check to see if your doctors and providers are included. If they aren't, you may need to pick a different plan or change your doctor to keep costs down.
Make sure you know what the out-of-pocket costs are for the plans you are looking at:
Most plans have a deductible. This is the amount you must pay before the plan pays their part.
Let's say your plan's deductible is $2,500. If you visit the doctor and they charge you $100, you will have to pay $100. If you already paid your deductible of $2,500, you will not have to pay the deductible of $100.
Most health plans will limit or "cap" the total amount you must pay out of pocket for the year.
After you meet your deductible, you will begin paying a copay. A copay is the flat amount you must pay, no matter the type of service. For most plans, you'll have a copay each time you see the doctor after meeting your deductible.
Coinsurance is the percentage of costs you must pay after you've met your deductible but before hitting your out-of-pocket limit. For example, let's say you've met your deductible but you need a surgery that costs $10,000. If your coinsurance is 25%, you would owe $2,500 and your insurer would pay the remaining $7,500.
Usually, the lower your monthly premium (i.e., the amount you pay each month), the higher your out-of-pocket costs will be.
If you are in good health and rarely need to visit a doctor, you might want a plan with higher out-of-pocket costs and a lower monthly premium.
You might want to choose a plan with a lower out-of-pocket cost and higher monthly premium if:
Now that you've done your homework, compared plans, and decided what’s right for you, it's time to sign up for your plan. We hope this website made the process easier.
Some people can get a tax credit to help pay for the monthly cost of a plan. To find out if you can get a tax credit, you must: (1) buy your plan on HealthCare.gov, and (2) file a tax return. You will not get the tax credit if you buy the plan through an insurance company. To learn more about tax credits, go to IRS.gov and HealthCare.gov.
To learn more about health insurance in Texas, go to our main TDI website or our Texas Health Options website.